Thyroxine replacement by colonic route and absorption kinetics: case report

Authors

  • Ricardo-Raziel Peña-González Department of General Surgery, Hospital General de México, Mexico City, Mexico
  • Jonathan Quiroz-Alvarez Department of General Surgery, Hospital General de México, Mexico City, Mexico
  • Jocelyn Sánchez-Paredes Department of General Surgery, Hospital General de México, Mexico City, Mexico
  • Juan-Carlos Juárez-Vanegas Department of General Surgery, Hospital General de México, Mexico City, Mexico
  • Daniel-Eduardo Aguilera-Callejas Department of General Surgery, Hospital General de México, Mexico City, Mexico
  • Antonio Segovia Department of Endocrinology, Hospital General de México, Mexico City, Mexico
  • Agustín Etchegaray-Dondé Department of General Surgery, Hospital General de México, Mexico City, Mexico
  • Francisco Higuera-Hidalgo Department of General Surgery, Hospital General de México, Mexico City, Mexico

DOI:

https://doi.org/10.18203/2349-2902.isj20240004

Keywords:

Enema, Hypothyroidism, Thyroxine

Abstract

In the literature there are only 2 reports of replacement of thyroid hormones by colonic route. The objective of this study is to present a clinical case where thyroid hormone replacement was performed through the application of enemas with levothyroxine. 78-year-old patient with hypothyroidism is presented who attended to the emergency room with intestinal occlusion, which presented refractory hypothyroidism secondary to intestinal occlusion and she underwent hormone replacement with enemas with levothyroxine. The kinetics of colonic absorption of thyroid hormones takes twice as long to reach the plateau of serum levels with respect to absorption in jejunum and ileum.

References

Benvenga S, Di Bari F. Intestinal absorption and buccal absorption of liquid levothyroxine. Endocrine. 2017;58(3):591-4.

Colucci P. Review of the pharmacokinetics of levothyroxine for the treatment of hypothyroidism. Eur Endocrinol. 2013;9(1):40-7.

Gadiraju S, Lee CJ, Cooper DS. Levothyroxine dosing following bariatric surgery. Obes Surg. 2016;26(10):2538-42.

Catalina PF, Carpio D. 2015. Levothyroxine malabsortion. Med Clin. 2015;145(1):46.

Amidon S, Brown JE, Dave VS. Colon-targeted oral drug delivery systems design trends and approaches. AAPS Pharm Sci Tech. 2015;16(4):731-41.

Patel M, Shah T, Amin A. Therapeutic opportunities in colon-specific drug-delivery systems. Crit Rev Ther Drug Carrier Syst. 2007;24(2):147-202.

Obeidat KA, Saadeh NA, As'ad A, Bakkar S. Successful Management of Hypothyroidism in Gastric Outlet Obstruction Using Levothyroxine Rectal Enemas. Am J Case Rep. 2018;19:903-5.

Ybarra M, Dos Santos TJ, Cabido CT, Dichtchekenian V, Damiani D. rectal levothyroxine for the treatment of hypothyroidism a case study. Pediatrics. 2018;142(2):e20173317.

Gonzales KM, Stan MN, Morris JC, Bernet V, Castro MR. The levothyroxine absorption test. Thyroid. 2019;29(12):1734-42.

Ghosh S, Pramanik S, Biswas K, Bhattacharjee K, Sarkar R, Chowdhury S, et al. Levothyroxine absorption test to differentiate pseudomalabsorption from true malabsorption. Eur Thyroid J. 2020;9(1):19-24.

Ianiro G, Mangiola F, Di Rienzo TA, Bibbò S, Franceschi F, Greco AV, Gasbarrini A. Levothyroxine absorption in health and disease, and new therapeutic perspectives. Eur Rev Med Pharmacol Sci. 2014;18(4):451-6.

Milla PJ. Advances in understanding colonic function. J Pediatr Gastroenterol Nutr. 2009;48(2):S43-5.

Geibel JP. Secretion and absorption by colonic crypts. Annu Rev Physiol. 2005;67:471-90.

Downloads

Published

2024-01-04

Issue

Section

Case Reports